Background to this inspection
Updated
14 November 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by three inspectors. Two inspectors visited the service and a third inspector collected and reviewed information we asked the registered manager to send us by email during the inspection.
Service and service type
Ashley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the provider less than 24 hours’ notice of the inspection. This was to check if any staff or people at the service had tested positive or had symptoms of COVID-19 and to discuss arrangements for the inspection and PPE required.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, professionals who work with the service and Healthwatch. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. The registered manager engaged in an Emergency Support Framework (ESF) call with a CQC inspector prior to the inspection. This is a supportive conversation CQC has held with providers or registered managers of all services during the COVID-19 pandemic crisis to check how they were managing. We used all this information to plan our inspection.
Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
During the inspection
We spoke with three relatives of people who lived at the service about their experience of the care provided. We spoke with seven members of staff including the registered manager, the deputy manager of another of the provider’s services, care workers and housekeeping staff.
We reviewed a range of records. This included three people’s care records, and three medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service including monitoring and auditing records were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We reviewed a range of documentary evidence including infection control records, staff meetings, residents’ meetings and auditing and monitoring documents. We asked for documents that were not supplied, including staff training and induction records and improvement plans, including maintenance planning.
Updated
14 November 2020
About the service
Ashley House is a residential care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 17 people in one adapted building.
People’s experience of using this service and what we found
Very few improvements had been made since the last inspection. There continued to be shortfalls in the service provided to people.
Risks to people in relation to fire safety and evacuation had not improved since the last inspection. Other environmental risks were evident and had not been recognised. Some people’s individual risk assessments had improved. Some areas, however, had been missed so care may not be sufficient to meet their needs.
People could not be assured their prescribed medicines were safely managed as monitoring measures were not sufficient to ensure safety. Although infection control procedures were in place, these were not robust enough to assure people they were being kept safe.
Although staff knew people well and knew what support they needed, their care was not always person-centred, taking account of their privacy and rights.
The provider had limited oversight of the service and had not planned to make the improvements needed since the last inspection. People could not be assured the service was going to make the necessary changes to ensure the quality and safety of their service.
Enough staff were available to make sure people received the support they needed. Some changes needed to be made to the management processes to assess the numbers of staff required. Staff employed to make sure people received safe care and support were checked by the registered manager, although some areas needed to be improved.
People were kept safe from abuse, the registered manager reported concerns and staff knew how to raise concerns and who with.
People had the opportunity to be involved in giving their views and being involved. They were supported by staff who were listened to and enjoyed their work.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 8 January 2020) and there were multiple breaches of regulation. The service remains rated requires improvement. The service has been rated requires improvement for the last four consecutive inspections.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced comprehensive inspection of this service on 3 October 2019. Breaches of legal requirements were found. We took enforcement action against the provider and registered manager. We served a warning notice, requiring them to be compliant with Regulation 17 by 28 February 2020.
We undertook this focused inspection to check the provider and registered manager had made improvements and to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service remains requires improvement overall. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashley House on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to Regulations 12 and 17 at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.